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iii
Instructor’s Resource Manual and Test Bank
for
The Voice and Voice Therapy
Ninth Edition
Daniel R. Boone University of Arizona
Stephen C. McFarlane University of Nevada Medical School
Shelley L. Von Berg California State University, Chico
Richard I. Zraick University of Arkansas for Medical Sciences
University of Arkansas at Little Rock
Boston Columbus Indianapolis New York San Francisco Upper Saddle River
Amsterdam Cape Town Dubai London Madrid Milan Munich Paris Montreal Toronto
Delhi Mexico City Sao Paulo Sydney Hong Kong Seoul Singapore Taipei Tokyo
Voice And Voice Therapy 9th Edition Boone Test BankFull Download: https://testbanklive.com/download/voice-and-voice-therapy-9th-edition-boone-test-bank/
Full download all chapters instantly please go to Solutions Manual, Test Bank site: TestBankLive.com
iv
Copyright © 2014, 2010, 2005, 2000, by Pearson Education, Inc., publishing as Allyn & Bacon.
All rights reserved. The contents, or parts thereof, may be reproduced with The Voice and Voice
Therapy, Ninth Edition, by Daniel R. Boone, Stephen C. McFarlane, Shelely L. Von Berg, and
Richard I. Zraick, provided such reproductions bear copyright notice, but may not be reproduced
in any form for any other purpose without written permission from the copyright owner.
To obtain permission(s) to use the material from this work, please submit a written request to
Pearson Education, Inc., Permissions Department, One Lake Street, Upper Saddle River, NJ
07458, or fax your request to 201-236-3290.
ISBN-10: 0-13-30184-7
www.pearsonhighered.com ISBN-13: 978-0-13-30184-9
v
The Voice and Voice Therapy Table of Contents Instructor’s Resource Manual, Learning Objectives and Classroom Activities
Chapter 1……………………………………………………………………1
Chapter 2……………………………………………………………………3
Chapter 3……………………………………………………………………6
Chapter 4……………………………………………………………………8
Chapter 5……………………………………………………………………10
Chapter 6……………………………………………………………………12
Chapter 7……………………………………………………………………14
Chapter 8……………………………………………………………………16
Chapter 9……………………………………………………………………18
Chapter 10…………………………………………………………………..20
Test Bank
Chapter 1……………………………………………………………………22
Chapter 2……………………………………………………………………25
Chapter 3……………………………………………………………………32
Chapter 4……………………………………………………………………38
Chapter 5……………………………………………………………………44
Chapter 6……………………………………………………………………48
Chapter 7……………………………………………………………………52
Chapter 8……………………………………………………………………55
Chapter 9……………………………………………………………………58
Chapter 10…………………………………………………………………..62
Answer Key
Chapter 1……………………………………………………………………66
Chapter 2……………………………………………………………………67
Chapter 3……………………………………………………………………72
Chapter 4……………………………………………………………………73
Chapter 5……………………………………………………………………74
Chapter 6……………………………………………………………………75
Chapter 7……………………………………………………………………76
Chapter 8……………………………………………………………………77
Chapter 9……………………………………………………………………78
Chapter 10…………………………………………………………………..79
1
Instructor’s Resource Manual: Overview, Learning Objectives and
Classroom Activities Chapter 1: An Introduction to Voice Disorders and their Management
Chapter overview
In this chapter we look at voice and the larynx in the biologic viability of the individual,
as a tool in emotional expression, and in its complicated and extensive role in spoken human
communication. We review the prevalence of voice disorders in the general population and in
specific subpopulations. We see that there appear to be three causal factors in the development
and maintenance of voice disorders: functional, organic, and neurogenic. The child or adult with
a voice problem is evaluated by the SLP who uses instrumental and non-instrumental approaches
for various respiratory and acoustic measures in the attempt to identify causal factors and define
aspects of voice production. “Diagnostic probes,” the application of trial therapy approaches, are
then used to determine the efficacy of a particular therapy technique for improving the patient’s
voice productions. The patient’s self-perception of the handicapping impact of the voice
disorder on his or her life is then recorded. If evaluation measures indicate that the patient can
profit from therapy, the SLP then provides needed voice therapy. At the conclusion of voice
therapy, therapy success is determined by comparing pre- and post-therapy measures, providing
needed outcome data.
Learning objectives:
After reading this chapter, the student should be able to:
1. List and describe the biological, emotional and linguistic functions of the larynx.
2. List and describe the kinds of voice disorders.
3. Describe the incidence and prevalence of voice disorders in the general population.
4. Describe the incidence and prevalence of voice disorders in specific populations.
5. Describe the types of intervention for voice disorders.
2
Classroom activities
1. To appreciate biological action of the larynx, place your index finger gently on your thyroid
cartilage and swallow. Note the ascension and forward movement. Now, describe how this
movement can interrupt the emotional and linguistic functions of the larynx. Turn to Chapter
7, Voice Facilitating Approaches, and identify three approaches that may lower the larynx for
improved voicing and speaking.
2. To appreciate the emotional function of the larynx, select three classmates. Write different
emotion states on single slips of paper and place in a cup. Emotional states can be happy, sad,
angry, excited, etc. As each student selects a piece of paper, the student speaks a neutral
phrase, such as, “I had eggs for breakfast.” However, the student speaks the phrase with the
emotional overlay as specified on the piece of paper. How many of your peers are able to
identify the emotional state just from the changes in your voice and prosodic intent?
3. To develop a solid understanding of incidence and prevalence, turn to Chapter 4, Organic
Voice Disorders, or Chapter 5, Neurogenic Voice Disorders. Select a pathology, and then
look up the pathology’s incidence and prevalence on a peer-reviewed website. One example
of a peer reviewed website is PubMed. Investigate and then share your findings with your
peers in class.
4. Provide three reasons why you think that the majority of children who require voice
intervention in the schools are not receiving it. You may need to look in other chapters to
complete this question.
5. Review the chapter section on voice disorders in teacher and student teachers. Then
investigate Elimination of Abuses in Chapter 7. Generate an “Elimination of vocal abuses”
chart that can be distributed to teachers and student teachers. Compare your chart with those
generated by your peers. How are they the same? Different?
Page keys to Classroom activities
1. Page 2 and Chapter 7 4. Page 7 and Chapter 8
2. Page 3 5. Page 8 and chapter 7
3. Page 5 and Chapters 4 and 5
Chapter 2: Normal Voice
Anatomy and Physiology Throughout The Lifespan
Chapter overview
In this chapter we learn about the respiratory, phonatory, and resonance aspects of voice,
and discuss the five aspects of voice (loudness, hygiene, pleasantness, flexibility, and
representation). We find that the outgoing airstream is the primary driving force of voice. A
description of the physiology of respiration introduces the structures and mechanisms of normal
breathing for speech. The efficient user of voice develops good expiratory control. The value and
magnitude of respiratory volumes are discussed. A description of the physiology of phonation
outlines the structures and mechanisms of normal phonation, including frequency, intensity, and
quality shaping mechanisms. Supraglottal structures and functions specific to quality and
resonance are discussed. The entire vocal tract contributes to the amplification and filtering of
the fundamental frequency into the final unique voice of any speaker. The understanding of these
processes provides the underpinning for effective voice therapy for patients with dysphonia.
Learning objectives
3
After reading this chapter, the students should be able to:
1. List and define the five aspects of the normal voice.
2. List and describe the three processes of normal voice production.
3. Identify the structures of respiration.
4. Describe the mechanics of respiration.
5. List and describe the lung volumes and capacities in reference to resting expiratory level.
6. Understand the differences between breathing for life and breathing for speech.
7. Describe the effects of aging on the respiratory system and speech breathing.
8. Identify the structures of phonation.
9. Describe the effects of aging on the laryngeal system.
10. Understand the myoelastic aerodynamic theory of vocal fold vibration.
11. Describe the factors involved in changing vocal pitch, loudness, and quality.
12. Identify the structures of resonance.
13. Describe the mechanics of resonance.
4
Classroom activities
1. Select four classmates so that you equal five. Sit at a round table so each student is
equidistant from a digital recorder in the middle of the table. Turn on the recorder and have a
brief conversation so that all voices are recorded. Now, play back the conversation and
identify each of the five aspects of voice. Are they interrelated? Does anyone have more of
one aspect or attribute than another student? Discuss.
2. Deconstruct the term myoelastic-aerodynamic theory of phonation using a balloon. Blow up
the balloon and note that the body of the balloon represents the lungs and the valve the vocal
folds. Now, release the air by stretching the valve tight. What is the sound quality like? High
or low? As you release the air, describe the dynamics that create the vibration. Now, reduce
the stretch by about 50%. Under which condition is more air exiting the “vocal folds?” What
happens to the vibrational quality? Does it increase or decrease? Blow up the balloon again
and simply release the valve. Note the non-periodic release of air. What type of laryngeal
pathology might mimic this uncontrolled release of “subglottal” pressure?
3. Now, let’s look at the difference between quiet breathing and breathing for speech. This
exercise is more meaningful if you use yourself or a classmate. First, sit quietly and count the
number of breaths that you take for 1 minute. It should be within the range of 17 to 22
breaths per minute and the inhalation and exhalation phases should be about equal. Look up
Figure 2.2 and identify the muscles that are primarily responsible for quiet breathing.
Now, orally read a four-paragraph passage. Make note of whether you take in air through
your nose or your mouth. How is this different from quiet breathing? Are the inhalation
and exhalation periods the same or different? Name the main muscles involved in
breathing for speech.
4. Go outside and find a garden hose. Turn the water on at its source, but only one turn. Try to
direct the water out several feet. What happens? Now, put your thumb over the end of the
hose and describe what happens. Now, turn the water up at its source and describe what
happens. If this hose is analogous to voice production whereby the end of the hose is the
larynx and the source of the voice is the lungs, how would you counsel a voice client with
vocal hyperfunction?
5. What factors determine fundamental frequency? Look around your house or apartment and
try to find items that can easily represent vocal folds. Past students have constructed vocal
fold configurations from empty tuna cans and rubber bands of varying widths, densities and
lengths to represent men’s, women’s and children’s vocal folds. Construct, and then ask your
classmates determine which set of vocal folds represents each fundamental frequency.
Page keys to Classroom activities
1. Page 19
2. Page 51
3. Pages 27-30
4. Page 29
5. Pages 53-54
5
Instructor’s Resource Manual: Overview, Learning Objectives and Classroom Activities
Chapter 3: Functional Voice Disorders
Chapter overview
This chapter introduces functional voice disorders - those that have no organic or
neurological cause. We describe voice disorders that result from excessive muscle tension, and
the benign laryngeal pathology that may develop. We also describe voice disorders with a
psycho-emotional basis or overlay. Numerous case studies are introduced that support the value
of Voice Facilitating Approaches in treating most functional and psychogenic voice disorders.
Learning objectives
After reading this chapter, one should be able to:
1. Define the term functional voice disorders
2. Define the term psychgenic voice disodres
3. Describe the benign pathologies which may result from excessive laryngeal tension.
4. Describe the voice symptoms of muscle tension dysphonia (MTD).
5. Describe the treatment options for MTD.
Classroom activities
1. Draw the vocal folds and the ventricular folds. Now, illustrate how the ventricular folds
might move toward the midline during voicing. Do the ventricular folds impinge on the true
vocal folds? What type of vocal quality would you expect from this physiological action?
Purchase or borrow an inexpensive tambourine. Tap it and note the frequency of vibration.
Now place a wad of play dough on the tambourine’s surface and tap again. How can this
altered frequency be compared with ventricular phonation?
2. Draw the vocal folds in an adducted and abducted position. Now add vocal nodules. Note the
hourglass configuration of the glottis during adduction. Do you think this would result in
longer or shorter phrase lengths? Explain.
3. Draw the vocal folds and illustrate a sessile versus a peduculated polyp. Why is it a good idea
to consider voice therapy before surgical approaches to specific types of polyps? Read
Chapter 7, and list three approaches that might be facilitative in reducing or eliminating a
sessile polyp.
4. List three changes that may occur to the surface mucosa during a shouting event.
5. Describe three different voice quality behaviors that you would expect to be abnormal for an
individual with Reinke’s edema. Sketch a cross section of the vocal fold and illustrate how
the thick, gelatinous fluid like material may interfere with the actions of the lamina propria.
Page keys to Classroom activities
1. Pages 67-68
2. Pages 69-70
3. Pages 72-73
4. Page 74
5. Page 73
6
Instructor’s Resource Manual: Overview, Learning Objectives and Classroom Activities
Chapter 4: Organic Voice Disorders
Chapter overview
Organic voice disorders may result from various laryngeal conditions, such as papilloma,
granuloma, webbing, and reflux. For each of the various organic voice disorders, we discuss
medical management and the role of the SLP in evaluation and therapy. It is the responsibility of
the SLP to be familiar with each voice disorder, its sequelae (e.g., signs and symptoms) and
management. By being familiar with the pathology of the voice disorder, we can better counsel
our clients and provide efficacious behavioral intervention. In many cases, we are the first
professional to detect an organic related voice disorder and the first professional to make the
critical referral to the ENT physician.
Learning objectives
After reading this chapter, one should be able to:
1. Identify the major organic causes of voice disorders.
2. Explain the underlying pathologies that cause and maintain these disorders.
3. Explain the medical and pharmacologic approaches to these organic disorders.
4. Describe how behavioral voice therapy intervention and lifestyle change counseling can
reduce the recurrence of these disorders.
5. List behavioral voice intervention techniques that may reduce some of the dysphonic
characteristics that accompany these disorders.
Classroom activities 1. Refer to Granuloma 2 in the color insert. Describe the location of the contact granuloma.
Would this location interfere with vocal fold vibration? Why? Why not? Describe why
patients with contact ulcers/granulomas often describe a sense of “globus.”
2. Sketch an illustration of the aerodigestive tract as if you were illustrating it for a voice client
diagnosed with laryngopharyngeal reflux disease. Label all of the structures of interest. Show
how the reflux can invade the laryngeal aditus and how it can travel superiorly to the nasal
cavities.
3. Visit three peer reviewed medical websites, such as Mayo Clinic, National Institutes of
Health and Johns Hopkins. Review behavioral treatment for LPRD. Are the treatments at
these sites consistent with treatment suggested on page 91? Generate your own Behavioral
Reflux Reduction sheet to share with patients.
4. Sketch the vocal folds, illustrating cysts, polyps and vocal nodules. Explain why visual
assessment alone --without stroboscopy (Chapter 6) -- might misinterpret these three
different lesions. Describe the etiologies and subsequent approaches to each of these lesions.
5. Refer to the Anterior Web in the color insert. Describe what you would expect to perceive
with respect to the pitch and amplitude of the voice. Would phrase lengths be short or long?
Describe the various approaches to laryngeal webs.
Page keys to Classroom activities
1. Pages 92-93
2. Pages 89-92
3. Page 91
4. Page 94 and Chapter 3
5. Page 101-102
7
Instructor’s Resource Manual: Overview, Learning Objectives and Classroom Activities
Chapter 5: Neurogenic Voice Disorders
Chapter overview
At the beginning of this chapter, we look at the neurological bases of human laryngeal
function. We introduce the latest research in behavioral, pharmacological, and surgical
management of neurogenic voice disorders and describe a number of Voice Facilitating
Approaches that have been effective for many patients presenting with dysarthria (see Chapter
7). The key to effective behavior-based intervention for patients presenting with static or
progressive neurogenic dysphonia is an understanding the nature of the deficits in the subsystems
of speech and knowing how to address them.
Learning objectives
After reviewing this chapter, one should be able to:
1. Describe the roles of the central and peripheral nervous systems in the innervation of the
vocal mechanism.
2. Identify the major role of each cranial nerve involved with voice production.
3. Recognize the origin in the nervous systems(s) and typical course of those neurogenic
disorders introduced.
4. Identify the latest in surgical, pharmacologic and behavioral management for each of the
disorders.
5. Describe the various Voice Facilitating Approaches that might be instrumental in modifying
select voice disorders of a neurogenic nature.
Classroom activities
1. Sketch the Vagus nerve using Figure 3 as a guide. Once that is complete, identify in writing
the muscles that are innervated by the pharyngeal plexus, the superior laryngeal nerve and
the recurrent laryngeal nerve. Using the CAPE-V (Chapter 6), describe the changes in voice
and resonance that would accompany lesions to each of these branches of the Vagus.
2. Sketch the vocal folds, illustrating the typical configuration of a unilateral vocal fold
paralysis. Describe how you would expect the voice to sound as measured by the CAPE-V?
Next, see Chapter 7 for three behavioral voice facilitating approaches to unilateral vocal fold
paralysis. Describe how each technique helps “normalize” the voice.
3. Collect two other students so that you form a group of three. Next, assign one student to
produce the voicing characteristics of essential tremor, student 2 to vocal hyperfunction and
student 3 to adductor spasmodic dysphonia. Record the voices and then play back and
discuss the perceptual similarities and differences. Finally, refer to Table 2 and discuss the
etiologies of each of these disorders.
4. Refer to Table 1 and review the type of dysarthria associated with Parkinson’s disease. List
the typical voicing changes you would expect to perceive as measured by the CAPE-V. Are
these voicing changes consistent with those vocal characteristics heard on the Parkinson’s
disease video link on page 117? Next, describe the holistic approach to Parkinson’s disease
advocated by the authors. What is meant by holistic?
5. Refer to Table 1 and review the types of dysarthrias that typically result from a CVA.
Describe why a flaccid dysarthria is consistent with a breathy voice, and why a spastic
dysarthria is consistent with a strained and strangled voice. Sketch the central and peripheral
8
nervous systems to illustrate your response. Then, describe three Voice Facilitating
Approaches that would effectively address each type of voice disorder.
Page keys to Classroom activities
1. Pages 113 and Chapters 2 and 6.
2. Pages 117-118.
3. Pages 120-127.
4. Pages 127-129
9
Instructor’s Resource Manual: Overview, Learning Objectives and Classroom Activities
Chapter 6: Evaluation of the Voice
Chapter overview
We begin this chapter with a brief discussion about screening individuals for voice
disorders. An overview of the laryngologist’s evaluation of the larynx follows. We then present
detailed information about the comprehensive voice evaluation, emphasizing the role of the SLP
clinician. The evaluation begins when the patient is observed in the waiting room and continues
as part of each therapy session, particularly as the clinician continually searches with the patient
for new vocal behaviors. The clinician must continue to evaluate and observe the patient's
respiratory, phonatory, and resonance functions. Whenever possible, these functions should be
quantified with instrumentation. Auditory-perceptual judgments are also extremely valuable in
describing the patient's voice disorder and the manner in which it is produced. The patient’s
perception of voice handicap is also important to assess. The patient's voice data are used for
comparison purposes, to quantify vocal changes between the first visit, subsequent therapy
sessions, and the final outcome session. Patient performance, both as observed and as measured,
is offered to the patient as continuing feedback, helping the patient become aware of voice
performance. The evaluation enables the voice clinician to decide on which management steps to
take for the patient, and to refer to additional disciplines when necessary.
Learning objectives
Upon reviewing this chapter, one should be able to:
1. Define the terms assessment, evaluation and diagnosis.
2. Describe the screening process for voice disorders.
3. List the major components of the voice assessment.
4. Describe the non-instrumental assessment of voice.
5. Describe the instrumental assessment of voice.
10
Classroom activities
1. Review the child voice screen instruments introduced in the text on pages 135-136. Generate
a booklet that contains stories or rhymes or songs (or all 3) that will elicit the voice behaviors
outlined in the two screening instruments. Your task is to generate materials that will engage
children and encourage them to produce sustained vowels, short phrases, and pitch slides. All
behaviors should be elicited in approximately 5 minutes or less.
2. Describe why it is important to ask a voice client about the onset, duration and variation of
the voice problem. Investigate and describe 3 etiologies that might underlie a sudden change
in voice and describe 3 etiologies that might underlie a gradual change in voice.
3. Go the ASHA website and locate the technical report on Vocal Tract Visualization and
Imaging. Select a subhead under table of contents and report your findings in class.
4. Find a family member or friend who has a disordered voice. Administer the CAPE-V and the
VHI. Do the results of the perceptual instrument match the individual’s self perception of
his/her voice? In other words, are the documented attributes of voice as measured by the
CAPE-V consistent with the individual’s self analysis of voice? In a summary paragraph,
document whether these scores are consistent with one another or whether there is a
discrepancy and why. Do you feel this individual requires a medical examination of voice?
5. Review the vocal dosage instruments introduced on pages 171-172. Describe how these
instruments capture voice use throughout the day. Now, create a general vocal hygiene chart
that you could distribute to voice clients to help them reduce vocal overuse and abuse, and
increase vocal health.
Page keys to classroom activities
1. Pages 135-136 5. Pages 171-172
2. Pages 143-143
3. Pages 151-152
4. Pages 146-148
11
Instructor’s Resource Manual: Overview, Learning Objectives and Classroom Activities
Chapter 7: Voice Facilitating Approaches
Chapter overview
In this chapter, we introduce and describe 25 Voice Facilitating Approaches that can be
used in symptomatic voice therapy. We provide the reader with extensive documentation of peer-
reviewed evidence to support each approach. In addition, each approach is demonstrated with
patients in linked videos. Most Voice Facilitating Approaches can be used individually; however,
there is clinical advantage to combining certain approaches together with particular patients. For
example, a typical voice therapy session might include counseling, use of the confidential voice,
head positioning, visual feedback, and the yawn–sigh, combined or used sequentially. Voice
therapy for most voice problems requires continuous assessment of what the patient is able to do
vocally. The selection of which therapy approach to use is highly individualized for the
particular patient, and no one approach is helpful for the same voice problem with every patient.
Learning objectives
After reading this chapter, one should be able to:
1. Describe the reasoning for the suggestion that there is no one voice approach or program
that is facilitative for all patients with the same voice problem.
2. Define the concept of “diagnostic probe” and explain its importance in voice therapy.
3. Identify the rationales and procedural approaches for the Voice Facilitating Approaches.
4. Identify at least one evidence based practice article that supports the target Voice
Facilitating Approach.
5. Identify emerging technologies in voice intervention that appear to be promising tools
when applied in conjunction with the guidance of the voice clinician.
12
Classroom activities
1. Select a Voice Facilitating Approach from the master list of 25. Write a summary
paragraph on the rationale for the technique and describe how it alters anatomy and
physiology. Investigate at least one peer-reviewed journal article not already in the text
that supports the approach. Present in class.
2. Studies have suggested that voice clients are more likely to adhere to their homework if it
is in video format rather than written format alone. Select a student partner and select 3
Voice Facilitating Approaches in the chapter. Each student will assume the role of the
voice client. Capture the techniques on video and play back. Do you agree that the video
format is more motivating that written homework alone?
3. Identify the Voice Facilitating Approaches that could be used for treating children with vocal
hyperfunction. Which approaches do you think children are most likely to incorporate into
their daily lives?
4. Describe why experienced voice clinicians avoid establishing pre-programmed therapy
sequences to various voice disorders. Defend your response in a summary paragraph.
5. Review the section for yawn-sigh in the text. Place your fingers lightly on your thyroid
cartilage. Does the larynx rise or descend for the yawn sigh? What happens to the diameter of
the throat? How does this alter the resonance of the voice? Practice with a student partner so
you feel comfortable with this approach.
Page keys to classroom activities
1. Page 188
2. Pages 186-187
3. Page 188
4. Page 187-188
5. Pages 240-241
13
Instructor’s Resource Manual: Overview, Learning Objectives and Classroom Activities
Chapter 8: Therapy for Special Patient Populations
Chapter overview
In this chapter we present voice disorders in children and adolescents, in older adults, in
those with hearing impairment , in those wishing to make the MtF or FtM gender conversion,
and in those with a variety of respiratory-based conditions. We also discuss the professional
voice user and the management of dysphonia in this increasing population of patients. While
patients from the aforementioned groups may also have primary or concomitant functional,
organic, or neurogenic contributors to their dysphonia, they each present unique management
challenges.
Learning objectives
After reading this chapter, one should be able to:
1. Understand the laryngeal and voice characteristics of the aging voice and describe its
management
2. Understand the laryngeal and voice characteristics of pediatric dysphonia, and describe its
management
3. List the professional voice use populations who are at risk for dysphonia, and describe the
management of dysphonia in these populations
4. Describe the speech and voice characteristics of the Deaf and Hard of Hearing populations
and approaches to these behaviors
5. Discuss the speech and voice management approaches to the TG populations
6. Describe respiratory based voice problems and management
7. Describe paradoxical vocal fold movement and its management
Classroom activities
1. Review the section on aging and describe why elderly individuals with hoarse vocal quality
should receive a medical evaluation. Next, access a sports club, independent senior living
community or adult community center and interview two individuals over 65. Questions may
be pulled from Chapter 6. Write a summary paragraph that captures the individuals’ vocal
health history and perceptions of voice. Share in class.
2. Review the section on child voice and then watch the video that illustrates sniff-swallow and
silent cough. Why are these two techniques so critical to share with children? Generate a
child-friendly vocal hygiene schedule and kit (personalized water bottle, stickers, chart) and
share in class.
3. In the section on professional voice users, we read that excessive noise may compromise
respiratory function, pitch changes, voice quality, and overall stability of the voice. Access a
sound level meter and visit one club or restaurant, and one day care center or elementary
school classroom in your area. If the sound levels are greater than 60dB SPL, what does this
suggest about how vocal users need to alter their pitch and loudness to be heard over the
noise? Is this considered vocally healthy? Investigate and share 3 approaches to increasing
vocal health in these challenging environments.
4. Generate 10 high predictability phrases that would be used by a person who is deaf or hard of
hearing and map the prosodic contours as outlined on page 254. Do your classmates agree
with the contours you generated?
5. Review the section on Transgender. Next, identify and record two female and two male
media personalities that you admire. Plot the voice and speech characteristics on the scale
14
provided in Figure 8.1. Do your classmates agree with your perceptual interpretations? If not,
why?
Page keys to classroom activities
1. Pages 243-247
2. Pages 247-248
3. Pages 250-251
4. Pages 253-254
5. Pages 255-256
15
Instructor’s Resource Manual: Overview, Learning Objectives and Classroom Activities
Chapter 9: Management and Therapy Following Laryngeal Cancer
Chapter overview
Chapter 9 introduces the types or modes of cancer treatment (radiation, surgery, and
chemotherapy) and their effect on the voice. Some case examples that demonstrate the voice
treatment approach used with patients undergoing each method of treatment are considered. Such
factors as vocal fold dryness and stiffness as well as absence of tissue post-treatment are
discussed. Voice Facilitating Approaches, which have been successful in producing vocal
improvement in patients who have been treated for laryngeal cancer, are introduced in detail. The
importance of such topics as vocal hygiene and pre-operative teaching for patients who have
been diagnosed with laryngeal cancer are presented. The treatment approaches for patients who
undergo total laryngectomy are provided as well. The methods used and references for further
information on these approaches are covered. Tracheoesophageal speech, esophageal speech and
artificial larynx communication options are described in detail.
Learning objectives
After reading this chapter, one should be able to:
1. Define TNM staging.
2. Define the modes of head and neck cancer treatment.
3. Define the inclusions important in pre-operative counseling.
4. Define post-operative methods of communication and advantages and disadvantages of
each.
5. Define the pharyngoesophageal (PE) segment and its role in both esophageal and
tracheoesophageal speech.
16
Classroom activities
1. Sketch a sagittal view of the head and neck showing normal vocal tract anatomy and altered
tract anatomy after total laryngectomy. Write a patient-friendly summary paragraph on the
changes and present in class.
2. Using modeling clay, build a model of the trachea and esophagus, including the upper
esophageal sphincter. Place a puncture where the TE puncture would be placed. Now,
describe how tracheoesophageal speech is produced.
3. Visit the website for the International Association of Laryngectomees. Find an IAL club
near you and ask if you can come to a meeting. If there is no IAL club near you, consider
collaborating with your classmates to begin one.
4. Select three classmates so that you equal four. Using the text and the IAL website, create a
pre-counseling laryngectomy in-service that can be used in any in-patient or outpatient
medical setting. Contact your local hospital and identify physicians who perform
laryngectomy surgeries in the area. Offer your in-service to these surgeons.
5. List two advantages and two drawbacks of the three primary communication modes after
laryngectomy. Are these modes of communication mutually exclusive? Explain.
Page key to Classroom activities
1. Pages 272-273
2. Pages 272-273, pages 283-284
3. Pages 275-276
4. Page 275-276
5. Pages 276-277
17
Instructor’s Resource Manual: Overview, Learning Objectives and Classroom Activities
Chapter 10: Resonance Disorders
Chapter overview
In chapter 10, we learn that resonance deviations of the voice are often produced by
physical problems of structure or function at various sites within the upper airway. Primary
efforts must be given to identifying any structural abnormalities and correcting these problems
by dental, medical, or surgical intervention. SLPs play an important role in the early evaluation
and diagnosis of a resonance problem, as well as in providing needed voice therapy to correct the
problem. Voice therapy is often necessary and very effective following surgical and dental
prosthetic treatments. For both organic and functional resonance problems, specific facilitating
approaches are listed to help patients develop better nasal and oral resonance.
Learning objectives
After reading this chapter one should be able to:
1. Describe the differences between hyper-, hypo-, and assimilative
nasality. Why do you think that these resonance disturbances are
considered as “nasal” by non-trained listeners?
2. Define two clinical probes that can be used to assess hypernasality. Explain physiologically
what is occurring during these probes.
3. Discuss why stimulability testing is so important.
4. Explain what can be determined regarding velopharyngeal function during an oral
examination.
5. Describe the various instrumental assessments of velopharyngeal function. Cite their
advantages and disadvantages.
6. Explain what testing can differentiate between hyper- and hyponasality.
7. Explain why the Voice Facilitating Approach of yawn-sigh is effective for reducing
stridency.
Classroom activities
1. Generate your own simple clinical assessment of resonance. Include in the kit a fogging
mirror, flashlight, straw, and age appropriate articulation screen. Pay close attention to the
stimuli that help differentiate hypernasality from hyponasality from assimilative nasality.
2. Now, identify a friend, classmate or acquaintance who presents with unusual resonance.
Evaluate this individual using the kit and additional probes described in Chapters 6 and 10.
Audio record the voice and speech and determine whether this individual presents with a
hyper-, hypo-, or assimilative nasality. What are the next steps you might take?
3. Sketch a sagittal section of the head and neck, including the nasal and oral cavities, and naso
and oral pharynges. Now sketch how the flexible fiberoptic endoscope is advanced through
the nasal cavity for an evaluation of VP port anatomy and physiology.
4. Using the same sketch generated for activity 3, identify whether an obturator or a palatal lift
would be appropriate for a child presenting with VP insufficiency. What about a client with
acquired spastic dysarthria? Defend your decisions in a summary paragraph. 5. Explain the rational and procedural aspects of glottal fry. Audiotape yourself producing
gottal fry and describe why it is a powerful approach for reducing stridency.
Page key for classroom activities
1. Page 292-298
18
2. Pages 291-293
3. Pages 301-302
4. Pages 291 and 307-308
5. Page 314
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